Skip to main content
SpringerLink
Log in

Apparent diffusion coefficient histogram analysis of neonatal hypoxic–ischemic encephalopathy

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Diffusion-weighted imaging is a valuable tool in the assessment of the neonatal brain, and changes in diffusion are seen in normal development as well as in pathological states such as hypoxic–ischemic encephalopathy (HIE). Various methods of quantitative assessment of diffusion values have been reported. Global ischemic injury occurring during the time of rapid developmental changes in brain myelination can complicate the imaging diagnosis of neonatal HIE.

Objective

To compare a quantitative method of histographic analysis of brain apparent coefficient (ADC) maps to the qualitative interpretation of routine brain MR imaging studies. We correlate changes in diffusion values with gestational age in radiographically normal neonates, and we investigate the sensitivity of the method as a quantitative measure of hypoxic–ischemic encephalopathy.

Materials and methods

We reviewed all brain MRI studies from the neonatal intensive care unit (NICU) at our university medical center over a 4-year period to identify cases that were radiographically normal (23 cases) and those with diffuse, global hypoxic–ischemic encephalopathy (12 cases). We histographically displayed ADC values of a single brain slice at the level of the basal ganglia and correlated peak (s-sDav) and lowest histogram values (s-sDlowest) with gestational age.

Results

Normative s-sDav values correlated significantly with gestational age and declined linearly through the neonatal period (r 2 = 0.477, P < 0.01). Six of 12 cases of known HIE demonstrated significantly lower s-sDav and s-sDlowest ADC values than were reflected in the normative distribution; several cases of HIE fell within a 95% confidence interval for normative studies, and one case demonstrated higher-than-normal s-sDav.

Conclusion

Single-slice histographic display of ADC values is a rapid and clinically feasible method of quantitative analysis of diffusion. In this study normative values derived from consecutive neonates without radiographic evidence of ischemic injury are correlated with gestational age, declining linearly throughout the perinatal period. This method does identify cases of HIE, though the overall sensitivity of the method is low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Barkovich AJ (2005) Brain and spine injuries in infancy and childhood. Pediatric neuroimaging. Lippincott, Williams and Wilkins, Philadelphia, pp 190–290

    Google Scholar 

  2. Heinz ER, Provenzale JM (2009) Imaging findings in neonatal hypoxia: a practical review. AJR Am J Roentgenol 192:41–47

    Article  PubMed  Google Scholar 

  3. Rutherford M, Srinivasan L, Dyet L et al (2006) Magnetic resonance imaging in perinatal brain injury: clinical presentation, lesions and outcome. Pediatr Radiol 36:582–592

    Article  PubMed  Google Scholar 

  4. Alderliesten T, de Vries LS, Benders MJ et al (2011) MR imaging and outcome of term neonates with perinatal asphyxia: value of diffusion-weighted MR imaging and (1)H MR spectroscopy. Radiology 261:235–242

    Article  PubMed  Google Scholar 

  5. Barkovich AJ, Miller SP, Bartha A et al (2006) MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy. AJNR Am J Neuroradiol 27:533–547

    CAS  PubMed  Google Scholar 

  6. Hunt RW, Neil JJ, Coleman LT et al (2004) Apparent diffusion coefficient in the posterior limb of the internal capsule predicts outcome after perinatal asphyxia. Pediatrics 114:999–1003

    Article  PubMed  Google Scholar 

  7. Liauw L, van Wezel-Meijler G, Veen S et al (2009) Do apparent diffusion coefficient measurements predict outcome in children with neonatal hypoxic–ischemic encephalopathy? AJNR Am J Neuroradiol 30:264–270

    Article  CAS  PubMed  Google Scholar 

  8. Okereafor A, Allsop J, Counsell SJ et al (2008) Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 121:906–914

    Article  PubMed  Google Scholar 

  9. Chun T, Filippi CG, Zimmerman RD et al (2000) Diffusion changes in the aging human brain. AJNR Am J Neuroradiol 21:1078–1083

    CAS  PubMed  Google Scholar 

  10. Rutherford M, Ramenghi LA, Edwards AD et al (2010) Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic–ischaemic encephalopathy: a nested substudy of a randomised controlled trial. Lancet Neurol 9:39–45

    Article  PubMed Central  PubMed  Google Scholar 

  11. Azzopardi DV, Strohm B, Edwards AD et al (2009) Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 361:1349–1358

    Article  CAS  PubMed  Google Scholar 

  12. Shankaran S, Laptook AR, Ehrenkranz RA et al (2005) Whole-body hypothermia for neonates with hypoxic–ischemic encephalopathy. N Engl J Med 353:1574–1584

    Article  CAS  PubMed  Google Scholar 

  13. Fisher M, Bogousslavsky J (1993) Evolving toward effective therapy for acute ischemic stroke. JAMA 270:360–364

    Article  CAS  PubMed  Google Scholar 

  14. Grotta J, Clark W, Coull B et al (1995) Safety and tolerability of the glutamate antagonist CGS 19755 (Selfotel) in patients with acute ischemic stroke. Results of a phase IIa randomized trial. Stroke 26:602–605

    Article  CAS  PubMed  Google Scholar 

  15. Ulug AM (2002) Monitoring brain development with quantitative diffusion tensor imaging. Dev Sci 5:286–292

    Article  Google Scholar 

  16. Zhang L, Thomas KM, Davidson MC et al (2005) MR quantitation of volume and diffusion changes in the developing brain. AJNR Am J Neuroradiol 26:45–49

    PubMed  Google Scholar 

  17. Lovblad KO, Schneider J, Ruoss K et al (2003) Isotropic apparent diffusion coefficient mapping of postnatal cerebral development. Neuroradiology 45:400–403

    Article  CAS  PubMed  Google Scholar 

  18. Provenzale JM, Isaacson J, Chen S et al (2010) Correlation of apparent diffusion coefficient and fractional anisotropy values in the developing infant brain. AJR Am J Roentgenol 195:W456–W462

    Article  PubMed Central  PubMed  Google Scholar 

  19. Neil JJ, Shiran SI, McKinstry RC et al (1998) Normal brain in human newborns: apparent diffusion coefficient and diffusion anisotropy measured by using diffusion tensor MR imaging. Radiology 209:57–66

    CAS  PubMed  Google Scholar 

  20. McKinstry RC, Miller JH, Snyder AZ et al (2002) A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns. Neurology 59:824–833

    Article  CAS  PubMed  Google Scholar 

  21. Toft PB, Leth H, Peitersen B et al (1996) The apparent diffusion coefficient of water in gray and white matter of the infant brain. J Comput Assist Tomogr 20:1006–1011

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA

    Keith A. Cauley

  2. Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, Harkness Pavilion, Rm. 313 180 Fort Washington Ave., 3rd Floor, New York, NY, 10032, USA

    Keith A. Cauley & Christopher G. Filippi

Authors
  1. Keith A. Cauley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher G. Filippi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keith A. Cauley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cauley, K.A., Filippi, C.G. Apparent diffusion coefficient histogram analysis of neonatal hypoxic–ischemic encephalopathy. Pediatr Radiol 44, 738–746 (2014). https://doi.org/10.1007/s00247-013-2864-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-013-2864-1

Keywords

Search

Navigation